Advancing Equity Through Primary Care and Digital Health Tools
35
Advancing Equity Through Primary Care and Digital Health Tools 1 Assistant Professor, Health Policy Director National Center for Primary Care Morehouse School of Medicine Megan Douglas, JD DISCLAIMER: The views and opinions expressed in this presentation are those of the author and do not necessarily represent official policy or position of HIMSS. Dominic Ma ck, MD, MBA Professor, Director National Center for Primary Care Morehouse School of Medicine
Transcript of Advancing Equity Through Primary Care and Digital Health Tools
Advancing Equity Through Primary Care and Digital Health Tools
1
Assistant Professor, Health Policy DirectorNational Center for Primary CareMorehouse School of Medicine
Megan Douglas , JD
DISCLAIMER: The views and opinions expressed in this presentation are those of the author and do not necessarily represent official policy or position of HIMSS.
Dominic Mack, MD, MBAProfessor, DirectorNational Center for Primary CareMorehouse School of Medicine
THE PRESENTATION TITLE GOES HERE
#HIMSS21 2
Meet Our Speakers
Megan Douglas , JD Dominic Mack, MD, MBA
Advancing Equity Through Primary Care and Digital Health Tools
THE PRESENTATION TITLE GOES HERE
#HIMSS21
Conflict of Interest
Megan Douglas, JD
Has no real or apparent conflicts of interest to report.
3
Advancing Equity Through Primary Care and Digital Health Tools
THE PRESENTATION TITLE GOES HERE
#HIMSS21
Conflict of Interest
Dominic Mack, MD, MBA
Has no real or apparent conflicts of interest to report.
4
Advancing Equity Through Primary Care and Digital Health Tools
THE PRESENTATION TITLE GOES HERE
#HIMSS21
Agenda
• Background
• Digital Health Tools Study
• Context & Next Steps
• Questions
5
Advancing Equity Through Primary Care and Digital Health Tools
THE PRESENTATION TITLE GOES HERE
#HIMSS21
Learning Objectives
• Discuss the effect of digital health tool adoption disparities among primary care clinicians on health equity
• Compare clinician, practice and policy-level factors associated with digital health tool adoption disparities in primary care
• Evaluate solutions to increase adoption of digital health tools by primary care clinicians serving underserved communities
6
Advancing Equity Through Primary Care and Digital Health Tools
7
“We are leading the creation and advancement of health equity”
Advancing Equity Through Primary Care and Digital Health Tools
8
“Strengthening the primary care system through education, research and training to improve health outcomes while advancing health equity”
Advancing Equity Through Primary Care and Digital Health Tools
Divisions• Health Policy• Research• Health IT• Substance Use Disorder Prevention & Treatment
Projects/Programs• HI-BRIDGE Solutions• Southeast Addiction Technology Transfer Center• Southeast Regional Clinicians Network• HBCU Global Health Consortium
9
• MACRA / QPP / MIPS and Medicaid Promoting Interoperability • EHR vendor selection / optimization• CMS, PECOS, and MAPIR registration and attestation
EHR Optimization Resource & Support
• Boots on the ground technical assistance• Distance Learning / Web-based training• Barrier mitigation / Security risk analysis
Outreach, Education & Training
• Service Area HIE with State HIE (interoperability)• Lab results and medication history review• HIE outreach and education
HIT Infrastructure
• Workflow Assessment/GAP Analysis• PCMH, ACOs, Clinical workflow redesign• Focus on improving clinical outcomes
Practice Management
• EHR adoption, Vendor utilization, Population HealthResearch
EMR Implementation Resource &
Support
Cloud-based Technical Solutions
Practice Management
Outreach, Education &
Training
Health Information Technology Division SUPPORTS GEORGIA PROVIDERS & HOSPITALS
56 HospitalsOver 4,000 Clinicians
Advancing Equity Through Primary Care and Digital Health Tools
10
About Kanyama Level One Hospital
• High volume with catchment population > 260,000 (designed for only 80,000)
• Total average monthly patient attendance of 23,400
• 14,220 Patients living with HIV on Antiretroviral Therapy (ART)
• Population HIV Prevalence Rate: 6-8% (all ages)
• Monthly HIV testing > 6,000
• ART Monthly average attendance of 5,500 clients
• Average wait time of 5 hours 30 minutes*
• 35-50 baby deliveries daily
*MSM assessment
HBCU Global Health ConsortiumMorehouse School of Medicine
2017-19: Overarching Program Objectives
Advancing Equity Through Primary Care and Digital Health Tools
11
“In order to understand the gap in adoption of digital health tools, the United Health Foundation is partnering with Morehouse School of Medicine’s National Center for
Primary Care on a digital health tools study to help rural and underserved communities.”
- Dr. Dominic Mack, Director of the National Center for Primary Care
Advancing Equity Through Primary Care and Digital Health Tools
12
Advancing Equity Through Primary Care and Digital Health Tools
13
Digital health tools have tremendous potential to aid in the elimination of health disparities, but only if they
are in the hands of the front-line clinicians serving
underserved communities.
Advancing Equity Through Primary Care and Digital Health Tools
14
Digital Health Tools StudyApproach
Advancing Equity Through Primary Care and Digital Health Tools
15
SURVEY
– Age, race, ethnicity, years of practice
– Credentials, practice setting/size
– Tech enthusiasm
– Participation in Quality Reporting Programs
− Specific DHTs− Barriers− Facilitators− Satisfaction− COVID-19
Demographics Digital Health Tools
Advancing Equity Through Primary Care and Digital Health Tools
16
State of Practice SpecialtyAdvancing Equity Through Primary Care and Digital Health Tools
17
Advancing Equity Through Primary Care and Digital Health Tools
18
Advancing Equity Through Primary Care and Digital Health Tools
19
Advancing Equity Through Primary Care and Digital Health Tools
20
Telemedicine (65%)Electronic health record (65%)Patient portal (50%)Health information exchange (45%)Prescription drug monitoring program (40%)Remote monitoring/home monitoring (30%)Wearable devices (20%)
AMA Digital Health Tool Survey (2019) Telemedicine (28%) Remote monitoring (22%) Patient Portal (58%)
Advancing Equity Through Primary Care and Digital Health Tools
21
Advancing Equity Through Primary Care and Digital Health Tools
22
55%
63%47%
43%
Advancing Equity Through Primary Care and Digital Health Tools
23
Advancing Equity Through Primary Care and Digital Health Tools
24
Clinicians who reported using [DHT] in the last 5 years were more likely to be:
Telemedicine: female; aged 40-49; in specialties of internal medicine, obstetrics/gynecology, geriatrics, pediatrics and behavioral health; solo practitioners, small practices or FQHCs; participating in Medicare EHR Incentive Program or Accountable Care Organization (ACO).
Health information exchange: affiliated with a medical school or academic medical center and participating in the Quality Payment Program (MIPS/APMs) or Chronic Care Management (CCM).
Electronic health records: Hispanic/Latino and nurse practitioners or physician assistants.
Remote monitoring: Hispanic/Latino; PhD; solo practitioners or large practices; and participating in CCM or the Medicaid EHR Incentive Program.
Patient portals: solo practitioners, small or large practices, hospitals with outpatient primary care, medical school/academic medical center or FQHC; and participating in an ACO.
Clinician Profiles (logistic regression, p<0.05)
Advancing Equity Through Primary Care and Digital Health Tools
25
FOCUS GROUPSAdvancing Equity Through Primary Care and Digital Health Tools
THE PRESENTATION TITLE GOES HERE
#HIMSS21 26
“ We're doing a lot of phone visits…because of…where we live, bandwith and internet connectivity, there's been some painful
appointments both via video and on phone. But when it works, it works very well. Patients are very receptive to it. It eliminates a barrier to access services, especially a transportation
barrier, which is very heavy in our community. So I think patients are really loving that.
Advancing Equity Through Primary Care and Digital Health Tools
THE PRESENTATION TITLE GOES HERE
#HIMSS21 27
“ [T]he other big issue…is really that digital divide in those that have the availability
and the capability to utilize different networks, cellular services, having both
video and audio capabilities. I think that's been one of the biggest barriers that we've
seen in our rural community.
Advancing Equity Through Primary Care and Digital Health Tools
THE PRESENTATION TITLE GOES HERE
#HIMSS21 28
“ [I]t's very frustrating to not be able to access records within my own system.
And I don't feel like anyone listens when I bring that up or maybe they do and it's just not possible. I don't know.
Advancing Equity Through Primary Care and Digital Health Tools
THE PRESENTATION TITLE GOES HERE
#HIMSS21
Key Takeaways
• Findings demonstrate significant increase in adoption of and satisfaction with
DHTs by primary care clinicians; however, some challenges have persisted
over the last 10+ years
• Primary care clinicians were generally satisfied with their DHT experiences
• To overcome workflow challenges, frontline clinicians should be engaged in
decision making
29
Advancing Equity Through Primary Care and Digital Health Tools
THE PRESENTATION TITLE GOES HERE
#HIMSS21
Health Equity Implications
• The digital divide continues to pose a barrier to DHT use by consumers and
clinicians in rural and underserved communities
• COVID-19 policy changes improved access to telehealth for racial and
ethnic minority and rural communities
• Value-based payment models rely on use of DHTs, but evidence of disparity
reduction is limited
30
Advancing Equity Through Primary Care and Digital Health Tools
THE PRESENTATION TITLE GOES HERE
#HIMSS21
COVID-19
• Widespread reliance on DHTs due to COVID-19, rapid increase in telehealth
adoption
• For telehealth, reimbursement for audio-only visits, home as presenting site &
expanded geographic limitations supported rapid uptake by clinicians and
new access for consumers• 90% of Black Americans live in urban communities
31
Advancing Equity Through Primary Care and Digital Health Tools
THE PRESENTATION TITLE GOES HERE
#HIMSS21
Value-Based Payment
• Associations between use of DHTs and participation in quality reporting
programs• ACO, QPP (MIPS/APM), CCM, Medicaid/Medicare EHR Incentive Programs
• Incentives for health equity must be assessed and re-visited
32
Advancing Equity Through Primary Care and Digital Health Tools
THE PRESENTATION TITLE GOES HERE
#HIMSS21 33
Next StepsLeadership RoundtablesVirtual ConveningSymposiumFinal Report
Advancing Equity Through Primary Care and Digital Health Tools
THE PRESENTATION TITLE GOES HERE
#HIMSS21
Meet Our Team
34
Anne Gagliot i, MD, FAAFP Denita T. Wals ton, MS Mitchell A. Blount , MPH Chaohua Li, MPH
Advancing Equity Through Primary Care and Digital Health Tools
THE PRESENTATION TITLE GOES HERE
#HIMSS21
Questions
35
Advancing Equity Through Primary Care and Digital Health Tools
Contact [email protected]
www.msm.edu/NCPC_DigitalHealthToolsStudy
MSM – National Center for Primary Care
@MSMNCPC
@NCPC_Policy
